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09/18/16 Doug McVay

King County, Seattle, Washington, will soon have two supervised drug consumption facilities. That recommendation is part of a final report by King County's Heroin and Prescription Opiate Task Force, which released its final report on Thursday Sept. 15.

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DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century Of Lies. Century Of Lies is a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay.

September Eighteenth through Twenty Fourth has been officially declared National Prescription Opioid and Heroin Epidemic Awareness Week. That's not the reason for the topic of today's show, it's merely a happy coincidence, just thought I'd mention it.

Years ago, elected officials, law enforcement, public defenders, criminal justice reform advocates, and harm reduction experts worked to come up with the Law Enforcement Assisted Diversion program, or LEAD, as it's called. Loyal listeners will recall that we recently discussed LEAD with Lorenzo Jones of the Katal Center. The LEAD program was first developed in King County, as a pilot program, and now it's part of county policy.

Decades ago, the first syringe exchanges in the United States were started up in Washington state. Washington passed its medical marijuana law in 1998, and in 2012 Washington became one of the first states in the US to pass an initiative partially legalizing adult social use of marijuana.

Like I say every year at Seattle Hempfest, for many years Washington state has truly been a leader in advancing drug policy reforms at the state level. Happily, that tradition continues.

Back in March of this year, King County set up a Heroin and Prescription Opiate Addiction Task Force. They were to come up with concrete proposals to help the community deal with problematic use of opiates and related problems such as overdoses and the transmission of HIV, AIDS, and hepatitis C.

On Thursday September 15th, the King County executive, county sheriff, mayors of Seattle and other cities, health officials and other public health workers, and advocates held a news conference to announce the release of that task force's final report and recommendations. Let's listen in.

The next voice you hear will be King County Executive Dow Constantine. He'll introduce the speakers who will include Seattle Mayor Ed Murray, Auburn Mayor Nancy Backus, Renton Mayor Denis Law, King County Sheriff John Urquhart, Jeff Duchin, MD, with Public Health Seattle and King County, and Brad Finegood with the King County Department of Community and Health Services.

KING COUNTY EXECUTIVE DOW CONSTANTINE: Well, thank you for being here. Good morning. I'm King County Executive Dow Constantine.

The heroin and opioid epidemic that has had a devastating impact across the country has hit every community across King County. It has spared no race, no age, no gender. It has spared no neighborhood or income level. More people in King County now enter detox for heroin than for alcohol. And they're doing so at a younger age. It's becoming more lethal, too. The number of fatal overdoses more than tripled between 2009 and 2014.

To confront this epidemic, we need a comprehensive regional approach that includes both immediate and long-term solutions. That's why in March, Seattle Mayor Ed Murray, Auburn Mayor Nancy Backus, and Renton Mayor Denis Law, joined with me and together we created a task force of leaders and experts from a wide range of disciplines: public health and human services; the justice system, police, prosecutors, public defenders; physicians and hospitals; UW researchers and local schools; cities and tribes; treatment providers; and parents of those who've lost children to this devastating disease.

Now, in a few minutes, our public health officer, Dr. Jeff Duchin, and Brad Finegood, assistant division director of the King County of Community and Human Services, will provide an overview of the task force recommendations. I want to thank though, right now, the members of this task force for contributing their time and their expertise, and their experience, and for delivering exactly what we asked them for: a comprehensive list of recommendations that provide a clear direction for confronting the heroin and opioid epidemic in our region.

Their report is based on the proven principles: that recovery is possible, it's possible through treatment, and that we can prevent people from suffering this disease in the first place, by increasing access to treatment on demand, the most effective way to help those who suffer from addiction. We're going to help more people once again live healthy, meaningful lives.

None of the recommendations will be free, though we've already paid a high price in the criminal justice system, in emergency rooms, and lower productivity, and most importantly, in lives that have been lost. Some of the recommendations will require careful legal consideration and thorough performance measurement to ensure that they are delivering the desired outcomes. But it is also just as important, as we carefully examine each recommendation, that we act with a sense of urgency.

When I met with the task force during their first meeting, I told them don't wait until you have this tied up with a ribbon. Let us know if you have a recommendation we need to act on right now to save lives, and they did that. They said, we need to get naloxone out there to more people, the life saving nasal spray that can reverse the effects of heroin overdose, and we're able to push 500 more kits out there to homeless service providers, to first responders, to law enforcement.

And our public health staff is starting a pilot project where they are making buprenorphine, a medication that's proven to help people safely transition off of heroin, more available to those at the highest risk of a fatal overdose.

So that's -- that's a kind of way we can approach this. This is the way in which we're going to succeed, with a unified, coordinated approach, so that everyone in our community, whether it's treatment providers or police officers, public health nurses or physicians, teachers or parents, any one of them can help and all of them working together can get people to the right treatment at the right place at the right time.

I know that we will succeed, because we have done it before, working across disciplines with communities to achieve a shared goal. So now, thanks again to the members of the task force, we are ready to really get to work. I'm going to hand this over now to the three mayors who co-convened the task force with me, starting with Seattle Mayor Ed Murray.

SEATTLE MAYOR ED MURRAY: Let me thank Executive Constantine for his initiative and leadership on this issue. The city of Seattle stands ready to be your partner, and working with our partners at King County Public Health. Let me also thank all of the individuals who are part of this task force for the work they put into this, for the courage of the vision that they have presented us, and for the challenge, and you just heard in the meeting we had earlier, the challenge they've made to us as the elected officials, to act as boldly as they have, and to act quickly.

You know, I'm very glad that my fellow mayors are here as well, because this epidemic is not restricted to one city. It is in cities across this country, it's in our suburban cities as well as our large cities. And if you look at a heat map of where needles are discovered in the city of Seattle, it's also not restricted to one neighborhood, or to one economic group, or to one race. But the challenge that we face, while the epidemic is everywhere, we have to ensure that when we act, and we act quickly, that we also act equitably. That the services that are needed are in those communities who have least access to healthcare.

Finally, I want to emphasize something I started with. It's not just a few cities in the west coast. It's a national crisis. And I again call on the federal government, as I did with 12 mayors across the country, to act on the Congressional appropriations for $103 million that could make a significant difference in all of our cities and all of our countries. So I would encourage everyone here, as they push us locally, to push our Congressional and Senate friends to act, and act now, while they're back in Congress. Thank you very much.

DOW CONSTANTINE: And now, we welcome the mayor of Auburn, Nancy Backus.

AUBURN MAYOR NANCY BACKUS: Good morning. I'd like to thank Executive Constantine, Mayor Murray, and Mayor Law, for allowing me to be part of the co-convening. It was a bold move, and it's one that needed to be taken. And I also want to thank each and every one of the task force members, who came at this with different perspectives, different ideas, different understandings of what the epidemic really was. And it required those different perspectives in order to have a successful outcome.

I am honored to be standing here today, but I'm also saddened that we have to be standing here today to talk about this epidemic. It's an entire report, there are 8 recommendations in this report. It's a lot to take in at one time. I look forward to reading each and every word, understanding each and every word, and then being part of the action that take place in order to save lives in our communities.

You know, there isn't really one face of addiction any longer. We can no longer drive by or walk by any one person and say, oh, that person is addicted to drugs. That's not the face any longer. It's our sons, it's our daughters, it's our mothers and fathers, it's our friends and loved ones, and we no longer have the luxury of pretending it doesn't impact each and every one of us.

There is no way that we can do that any longer. Don't we owe it to every one of the people out there that is addicted, to provide a strong pathway out of addiction? Thank you very much for being here today, and I would like to introduce my friend, Mayor Law from Renton.

RENTON MAYOR DENIS LAW: Well, good morning everybody. I too just want to join the Executive and Mayor Murray in emphasizing the fact that this is such a huge epidemic, and something that we all needed to get behind. I think one of the things that is really clear that, you know, back in the '90s, we would think of this as being a big city issue, and it doesn't spread out into the suburban cities much. But that's not the case. So we all know that all of the communities, as been mentioned earlier, every neighborhood, every facet of the community is suffering from this type of an issue, and so, it's really important that we all come together.

I think Nancy and I really appreciate the fact that we got to represent suburban cities and all of the communities around King County, and join in the efforts that this task force has come up with in terms of trying to make a difference.

DOUG MCVAY: That's from a news conference in King County, Seattle, Washington, on Thursday September Fifteenth. This audio comes to us courtesy of King County TV, a government access channel. We are using it by permission of King County TV, my thanks to KCTV and their director James Burns.

Officials were announcing the release of their Heroin and Prescription Opiate Addiction Task Force Final Report and Recommendations. Along with expanding treatment services, expanding the availability of Buprenorphine, and expanding the availability of the overdose reversal drug naloxone, King County plans to set up, on a pilot program basis, two Community Health Engagement Locations where drug consumption by adults may occur under the supervision of trained healthcare professionals.

The city of Vancouver, British Columbia, Canada, has had a supervised injection facility for many years now. The Insite program has been tremendously successful at not just reducing the risk of transmission of AIDS, HIV, and hepatitis C, and of reducing overdose mortality; they've also been able to help a number of their clients enter treatment. Supervised consumption facilities have been in operation around the world, successfully, for many years. The fact that the US has been so slow to adopt this simple, effective harm reduction tactic is tragic.

The speakers at that news conference we're listening to include King County Executive Dow Constantine, Seattle Mayor Ed Murray, Auburn Mayor Nancy Backus, Renton Mayor Denis Law, King County Sheriff John Urquhart, and others.

We'll hear more from them in a moment.

You're listening to Century of Lies, a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org.

September is National Recovery Month. It's a time when problematic substance use, addiction treatment, and recovery are supposed to at the forefront. As I mentioned at the top of the show, the White House has also declared September 18 through September 24, 2016, as Prescription Opioid and Heroin Epidemic Awareness Week. The President, the Drug Czar, and – I'm not making this up – Agriculture Secretary Tom Vilsack will be traveling the country to talk about addiction, and mostly to pander, and try to get votes for the upcoming general election.

The feds have been working very slowly to expand buprenorphine access, and we were able to get the federal funding ban on syringe exchanges lifted once more in the last budget bill, I mean, who knows what will happen this next time, or the time after that, because that federal funding ban comes up every single year. The president, the drug czar, and Agriculture Secretary Vilsack will be traveling to Kentucky and West Virginia, maybe Massachusetts, to learn ... something?

One place that's not on their itinerary yet but should be is King County, Seattle, Washington. Seattle is about to become home to the first official supervised drug consumption facility in the United States. I mean, imagine that, dear listener. By virtue of listening to this program, when it comes to innovative, effective approaches for dealing with problematic use of heroin and other opioids, you are now better informed than the president, the drug czar, even the secretary of agriculture.

So let's hear more from that news conference. Speakers included King County Executive Dow Constantine, Seattle Mayor Ed Murray, Auburn Mayor Nancy Backus, Renton Mayor Denis Law, King County Sheriff John Urquhart, Jeff Duchin, MD, with Public Health Seattle, and Brad Finegood with the King County Department of Community and Health Services.

JEFF DUCHIN, MD: I'm Jeff Duchin, I'm the Health Officer for Public Health Seattle & King County, and I just want to start by making sure you all know that the recommendations of this task force are based on the truth, that opiate -- opioid and heroin use disorder is a medical condition that is treatable, and should be treated with a public health and medical approach, like other diseases, like other medical conditions, and these persons can be returned to health and we can prevent others from becoming sick, using those approaches.

The task force also wants to emphasize that this is an increasingly large and complex problem, and requires multiple strategies and actions. There is no one single answer among our recommendations. It is a set of recommendations that are all important. I'm going to talk to you now about the first set of recommendations, and then my co-chair, Brad Finegood, will talk about others.

So the first set of recommendations is to reduce drug related overdose deaths by expanding the distribution of naloxone to individuals using heroin and pharmaceutical opioid drugs, their social networks, and to professionals who may administer naloxone through the course of their work. Now, this may include pharmacies, prescribers of medications, outreach workers, jails, staff at housing and health services where opiate overdoses are likely to occur.

We also recommend that we evaluate carefully the use of naloxone by police, fire, emergency medical services, social and health services staff, and others who administer it in the course of their work, to determine how well it is working and its impact. And we recommend expanding overdose education to the public and others to inform them about how overdoses can be recognized, prevented in the field, and about our Good Samaritan Law in Washington state.

Our second major recommendation is to establish on a pilot program basis at least two settings for persons with substance use disorders where observed consumption of illicit drugs occurs, under the supervision of a healthcare worker. These are called Community Health Engagement, or CHEL sites, and given the widespread distribution of drug use across King County, at least one of these sites should be outside the city of Seattle.

These sites will provide individuals with opioid use disorder a portal to return to healthy lives by reducing overdoses, preventing infections such as hepatitis B and C, and HIV, and other drug related medical problems, by increasing access to drug treatment services, and providing a safe and non-threatening environment where persons can receive help for other medical and behavioral health problems and the social service needs.

These sites have been shown elsewhere in the world to reduce health problems, to reduce public drug use, and the discarding of drug using equipment, while not increasing drug use, crime, or negative impacts in the community. And there's a particular focus on individuals who may not engage in traditional treatment related to substance use who are otherwise socially marginalized, and these sites will be offered in hot spot locations where drug use is already currently occurring.

I want to emphasize again that these are only one of a number of overall public health and medical recommendations and actions that must be employed to address our heroin and opioid drug crisis. And with -- as with all of our recommendations, we recommend ongoing evaluation to monitor the impact of this strategy.

I'm now going to turn the podium over to Brad Finegood, who will present the remainder of the task force recommendations.

BRAD FINEGOOD: Good morning, my name's Brad Finegood. That's the proper pronunciation for my -- just so my mom can be proud.

I just want to say Happy National Recovery Month to everybody. It's amazing that we can be here on National Recovery Month. Eleven years, nine months, and fifteen days ago, my brother passed away of an overdose. So being here today, and participating in this task force, has been extremely mission driven for me, and not only just for me, but everybody you see standing behind me as part of this task force.

As Jeff talked about, this task force convened only six months ago. Not only did the task seem so monumental at the time that we thought we could not come up with this report, but I never thought that the quality of the work that we were able to do was going to be as high as it's been. The task force and report has been driven by such an amazing array of perspectives and expertise. It's truly been an honor to serve.

Not included in the recommendations is probably the most powerful message that I have learned: The power of speaking up. The power of talking. The power of sharing a conversation. We learned that the task force -- we learned this at the task force meetings, and at the table of our community conversations, including in Renton, where we had over 120 people come to the table to talk about solutions.

There's so many people impacted by substance use disorder, in order to end prejudice and stigma, we must continue to talk and learn. We must understand opiate use disorder is a medical condition, as the doctor talked about. It's not a moral deficiency, and it's not a character flaw. The epidemic that we have in front of our face needs to be treated as a public health condition. We must provide services in order to improve health outcomes and engage people that are truly in need of this service.

We must also provide treatment and prevention services as we are recommending. The three treatment expansion and enhancement recommendations are as follows: Number one, create access to medication assisted treatment, including buprenorphine, for all people in need of services, in low-barrier modalities, close to where individuals live. The second treatment expansion recommendation is as follows: Develop treatment on demand for all modalities of substance use disorder treatment and services. We know that people who have to wait for treatment are much less likely to engage in treatment. Alleviate artificial barriers placed upon opiate treatment programs.

The third -- I'm sorry, the third group of recommendations that we have is around primary prevention. We know that we can't just treat the epidemic, but we have to keep the epidemic from continuing to get worse and worse as the next generations come on. We must raise aware -- recommendation number one: We must raise awareness and knowledge of the possible adverse effects of opiate use and opiate use disorder, including overdose prevention. Number two, we must promote safe storage and disposal of medication. We know that nationally, 80 percent of people who start using heroin, start using with prescription drugs. Number three: We must leverage and augment existing screening practices in schools and healthcare settings to prevent opiate use disorder and identify opiate use disorder early on.

Thanks to everyone here today, and all the support that we have received on this task force by our conveners, and by everybody in the community. I would like to introduce to you Sheriff Urquhart.

JOHN URQUHART: Well, good morning. If there's anybody in the room named Jack, my next comment is not meant for you, when I say, hit the road, Jack. What I'm referring to is the great singer Ray Charles. Ray Charles was arrested in the city of Seattle in the 1950s for possession of heroin, by the Seattle Police Department, in the central area. Presumably that was the beginning, or part of the war on drugs, although it wasn't called the war on drugs back then, that's a Nixonian change.

But I'm here to tell you, the war on drugs hasn't worked. I was a foot soldier in it, so I have a little bit of experience, but I know that it has been a failure. It's been an abject failure, actually, so we have to try something different. I was very pleased that the sheriff's office could participate in this particular task force, but it's not our first rodeo. Recently I was in Washington, DC, at a task force convened by the drug czar, Michael Botticelli, and was very interested to hear what other cities, communities, states, are doing about the heroin problem. And it's really reassuring to see that King County is so far ahead of many communities, who are still debating whether they should have needle exchanges or not. And some of them that do have needle exchanges are prohibited by law to call them needle exchanges. We are way past that, folks, so that's good news.

I also recently appeared on a television program, talking about opiate addiction and our response to that. It's called Adam Ruins Everything. If you've never seen that show, it's pretty interesting, and what he is going to talk about in this next show will be fascinating to this group, I think.

Finally, what is so reassuring is, when you talk about heroin in particular, is we've gone from a bunch of cops sitting around the table, fighting heroin, to a group like this, who includes a cop or two, but most of the people here have either MD or PhD, or ACLU, after their name, because it's not a problem that I can solve, or my deputies can solve, or any police officer can solve. It's a community problem that has to be solved by everybody. And I'm very happy that that's what we're trying to do right now.

Let me introduce Carissa Fonteneau, and I hope I pronounced her name correctly. Close enough? You know who you are. All right. Doctor.

CHARISSA FOTINOS, MD: Hi, my name's Charissa Fotinos, I am a family physician and addiction medicine physician. I wear a couple of hats today, one is that I represent the state of Washington Medicaid and Public Employee Benefit Program as one of their medical directors. I also am a citizen of King County. But I'm going to speak today as a physician who has taken care of patients who have died as a result of their opiate use disorder, patients who have died from complications related to their opiate use disorder, and patients who have managed to figure out, with the right supports and evidence based treatment, how they can manage this chronic condition.

It is not a switch we turn on nor we turn off, it is not a choice, it is a combination of genetic, environmental, social factors that lead people to substance use disorders, and the thing that I want to leave you with is, as a physician, I can listen. That's probably the most powerful thing I have to give my patients. I can also write prescriptions. There are very few prescriptions I can write that are as powerful as a prescription for either buprenorphine, methadone, and perhaps we'll find out in the future, long-acting naloxone. I can reduce a person's risk of dying by 50 percent by writing that prescription.

There is nothing more powerful as a physician I can do. I cannot cut heart disease in half, I cannot cure diabetes. I cannot even get a common cold to end sooner. But by writing a prescription with the appropriate treatment for someone who is struggling and barely managing day to day, I can reduce their risk of dying by 50 percent. It is my job to help my colleagues understand that, it is my job to applaud the work of this task force and the leadership of King County, both from my individual perspective and as a representative of the state, and I say thank you. We have an opportunity here. This is not doom and gloom, we have things that work, we have enthusiastic people who are ready to do it, and I think that the burden is on us to go forward. Thank you.

DOUG MCVAY: That again was a news conference in Seattle, Washington, to release their Heroin and Prescription Opiate Task Force's Final Report and Recommendations. This audio comes to us courtesy of King County TV, a government access channel.

Among other items, plans were announced to open the first officially recognized and supported supervised consumption facilities in the United States. It's a huge step forward for drug policy reform in the US, it's a giant leap forward for public health, and with luck, this is just the beginning.

For now, that's all the time we have today. Thank you for joining us. You have been listening to Century Of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I'm your host Doug McVay, editor of DrugWarFacts.org. Drug Truth Network is on Facebook, please give its page a like. Drug War Facts is on Facebook too, give it a like and share it with friends. You can follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty minutes of news and information about the drug war and this Century Of Lies. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.